DVT/VTE_Lect 14

Question 1

Is presence of DVT a necessary comorbidity of Pulmonary Embolism?

Answer 1

No. DVT is not present in 20% of Pulmonary Embolism patients

Question 2

Acquired Risk factors for VTE?

Answer 2

Stasis (travel, casting, pregnancy)
Endothelial Injury (trauma, surgery)
Hypercoagulability (malignancy, HF, meds)

Question 3

Inherited Risk factors for VTE?

Answer 3

Factor 5 Leiden
Prothombin mutation
Protein S/C deficiency
Antithrombin deficiency 
**Anatomic  (May Thurner Syndrome - right illiac artery compresses left illiac vein)

Question 4

How to diagnose DVT?

Answer 4

D-dimer (high in VTE patients; great negative predictive value in low prevalence population)
Wells Score (DVT = score >2)
Physical exam (nonspecific)
Ultrasound (TEST OF CHOICE; repeat in 5-7 days with high suspicion but neg tests)
Venography
CT w/ contrast
MRV
Impedance plethysmography
Contrast venography

Question 5

treatment for DVT?

Answer 5

UFH>LMWH/Fonda then warfarin>3months

Massive: use catheter thrombolyse/IVC filter (IVC cant be used longterm)

Question 6

Is pulm infarct common in PE?

Answer 6

No because of the dual supply of lung

Question 7

Treatment for PE?

Answer 7

LMWH for stable; UFH for unstable/high bleed risk, Warfarin at least 3 months